|
DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [12118]
|
Facility
|
IP
|
$15.02
|
|
|
Service Code
|
HCPCS J7042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Medicare |
$9.61
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.57
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.16
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Multiplan Medicare/VA |
$8.70
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.16
|
| Rate for Payer: United Healthcare Commercial |
$14.34
|
| Rate for Payer: United Healthcare Medicare |
$9.16
|
| Rate for Payer: WINHealth Partners Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
|
|
DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [12118]
|
Facility
|
OP
|
$15.02
|
|
|
Service Code
|
HCPCS J7042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.57
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.56
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Multiplan Medicare/VA |
$8.13
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$14.34
|
| Rate for Payer: United Healthcare Medicare |
$8.56
|
| Rate for Payer: WINHealth Partners Commercial |
$14.72
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
|
|
DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION [8337]
|
Facility
|
IP
|
$15.01
|
|
|
Service Code
|
NDC 0264775100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$15.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.61
|
| Rate for Payer: Altius Commercial |
$14.41
|
| Rate for Payer: Beech Street Commercial |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.56
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.56
|
| Rate for Payer: Cigna of WY Commercial |
$14.71
|
| Rate for Payer: Entrust Commercial |
$14.26
|
| Rate for Payer: First Choice Health Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.16
|
| Rate for Payer: HealthUtah PPO |
$15.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.56
|
| Rate for Payer: Multiplan Medicare/VA |
$8.70
|
| Rate for Payer: One Health Plan of WY PPO |
$14.71
|
| Rate for Payer: PacificSource Commercial |
$13.51
|
| Rate for Payer: PHCS PPO |
$14.71
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.16
|
| Rate for Payer: United Healthcare Commercial |
$14.33
|
| Rate for Payer: United Healthcare Medicare |
$9.16
|
| Rate for Payer: WINHealth Partners Commercial |
$14.26
|
| Rate for Payer: Wise Provider Network Commercial |
$14.26
|
|
|
DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION [8337]
|
Facility
|
OP
|
$15.01
|
|
|
Service Code
|
NDC 0264775100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$15.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Commercial |
$14.41
|
| Rate for Payer: Beech Street Commercial |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.56
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.56
|
| Rate for Payer: Cigna of WY Commercial |
$14.71
|
| Rate for Payer: Entrust Commercial |
$14.26
|
| Rate for Payer: First Choice Health Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.56
|
| Rate for Payer: HealthUtah PPO |
$15.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.56
|
| Rate for Payer: Multiplan Medicare/VA |
$8.13
|
| Rate for Payer: One Health Plan of WY PPO |
$14.71
|
| Rate for Payer: PacificSource Commercial |
$13.51
|
| Rate for Payer: PHCS PPO |
$14.71
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$14.33
|
| Rate for Payer: United Healthcare Medicare |
$8.56
|
| Rate for Payer: WINHealth Partners Commercial |
$14.71
|
| Rate for Payer: Wise Provider Network Commercial |
$14.26
|
|
|
DEXTROSE 5 % IN LACTATED RINGERS IV BOLUS [400297]
|
Facility
|
OP
|
$15.01
|
|
|
Service Code
|
NDC 0264775100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$15.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Commercial |
$14.41
|
| Rate for Payer: Beech Street Commercial |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.56
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.56
|
| Rate for Payer: Cigna of WY Commercial |
$14.71
|
| Rate for Payer: Entrust Commercial |
$14.26
|
| Rate for Payer: First Choice Health Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.56
|
| Rate for Payer: HealthUtah PPO |
$15.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.56
|
| Rate for Payer: Multiplan Medicare/VA |
$8.13
|
| Rate for Payer: One Health Plan of WY PPO |
$14.71
|
| Rate for Payer: PacificSource Commercial |
$13.51
|
| Rate for Payer: PHCS PPO |
$14.71
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$14.33
|
| Rate for Payer: United Healthcare Medicare |
$8.56
|
| Rate for Payer: WINHealth Partners Commercial |
$14.71
|
| Rate for Payer: Wise Provider Network Commercial |
$14.26
|
|
|
DEXTROSE 5 % IN LACTATED RINGERS IV BOLUS [400297]
|
Facility
|
IP
|
$15.01
|
|
|
Service Code
|
NDC 0264775100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$15.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.61
|
| Rate for Payer: Altius Commercial |
$14.41
|
| Rate for Payer: Beech Street Commercial |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.56
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.56
|
| Rate for Payer: Cigna of WY Commercial |
$14.71
|
| Rate for Payer: Entrust Commercial |
$14.26
|
| Rate for Payer: First Choice Health Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.16
|
| Rate for Payer: HealthUtah PPO |
$15.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.56
|
| Rate for Payer: Multiplan Medicare/VA |
$8.70
|
| Rate for Payer: One Health Plan of WY PPO |
$14.71
|
| Rate for Payer: PacificSource Commercial |
$13.51
|
| Rate for Payer: PHCS PPO |
$14.71
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.16
|
| Rate for Payer: United Healthcare Commercial |
$14.33
|
| Rate for Payer: United Healthcare Medicare |
$9.16
|
| Rate for Payer: WINHealth Partners Commercial |
$14.26
|
| Rate for Payer: Wise Provider Network Commercial |
$14.26
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [25389]
|
Facility
|
IP
|
$15.03
|
|
|
Service Code
|
HCPCS J7060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.87
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.75
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.80
|
| Rate for Payer: Aetna of WY Medicare |
$9.62
|
| Rate for Payer: Aetna of WY Medicare |
$9.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.66
|
| Rate for Payer: Aetna of WY Medicare |
$9.63
|
| Rate for Payer: Aetna of WY Medicare |
$9.61
|
| Rate for Payer: Altius Commercial |
$14.50
|
| Rate for Payer: Altius Commercial |
$14.56
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.45
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.75
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Beech Street Commercial |
$14.87
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Beech Street Commercial |
$14.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: Cigna of WY Commercial |
$14.87
|
| Rate for Payer: Cigna of WY Commercial |
$14.75
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Cigna of WY Commercial |
$14.80
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: Entrust Commercial |
$14.41
|
| Rate for Payer: Entrust Commercial |
$14.30
|
| Rate for Payer: Entrust Commercial |
$14.34
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.41
|
| Rate for Payer: First Choice Health Commercial |
$14.30
|
| Rate for Payer: First Choice Health Commercial |
$14.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.21
|
| Rate for Payer: HealthUtah PPO |
$15.10
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: HealthUtah PPO |
$15.05
|
| Rate for Payer: HealthUtah PPO |
$15.17
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.60
|
| Rate for Payer: Multiplan Medicare/VA |
$8.79
|
| Rate for Payer: Multiplan Medicare/VA |
$8.70
|
| Rate for Payer: Multiplan Medicare/VA |
$8.71
|
| Rate for Payer: Multiplan Medicare/VA |
$8.72
|
| Rate for Payer: Multiplan Medicare/VA |
$8.75
|
| Rate for Payer: One Health Plan of WY PPO |
$14.75
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: One Health Plan of WY PPO |
$14.80
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: One Health Plan of WY PPO |
$14.87
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PacificSource Commercial |
$13.54
|
| Rate for Payer: PacificSource Commercial |
$13.65
|
| Rate for Payer: PacificSource Commercial |
$13.59
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.87
|
| Rate for Payer: PHCS PPO |
$14.75
|
| Rate for Payer: PHCS PPO |
$14.80
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: Three Rivers PPO |
$11.32
|
| Rate for Payer: Three Rivers PPO |
$11.38
|
| Rate for Payer: Three Rivers PPO |
$11.29
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.17
|
| Rate for Payer: TriWest Veterans Administration |
$9.18
|
| Rate for Payer: TriWest Veterans Administration |
$9.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.21
|
| Rate for Payer: TriWest Veterans Administration |
$9.25
|
| Rate for Payer: United Healthcare Commercial |
$14.42
|
| Rate for Payer: United Healthcare Commercial |
$14.37
|
| Rate for Payer: United Healthcare Commercial |
$14.35
|
| Rate for Payer: United Healthcare Commercial |
$14.34
|
| Rate for Payer: United Healthcare Commercial |
$14.49
|
| Rate for Payer: United Healthcare Medicare |
$9.18
|
| Rate for Payer: United Healthcare Medicare |
$9.17
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: United Healthcare Medicare |
$9.16
|
| Rate for Payer: United Healthcare Medicare |
$9.21
|
| Rate for Payer: WINHealth Partners Commercial |
$14.28
|
| Rate for Payer: WINHealth Partners Commercial |
$14.34
|
| Rate for Payer: WINHealth Partners Commercial |
$14.41
|
| Rate for Payer: WINHealth Partners Commercial |
$14.30
|
| Rate for Payer: WINHealth Partners Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.41
|
| Rate for Payer: Wise Provider Network Commercial |
$14.34
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
| Rate for Payer: Wise Provider Network Commercial |
$14.30
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [25389]
|
Facility
|
OP
|
$15.02
|
|
|
Service Code
|
HCPCS J7060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.87
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.75
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.80
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Aetna of WY Medicare |
$9.97
|
| Rate for Payer: Aetna of WY Medicare |
$10.01
|
| Rate for Payer: Aetna of WY Medicare |
$9.93
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.56
|
| Rate for Payer: Altius Commercial |
$14.45
|
| Rate for Payer: Altius Commercial |
$14.50
|
| Rate for Payer: Beech Street Commercial |
$14.80
|
| Rate for Payer: Beech Street Commercial |
$14.75
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Beech Street Commercial |
$14.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.60
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.80
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Cigna of WY Commercial |
$14.75
|
| Rate for Payer: Cigna of WY Commercial |
$14.87
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: Entrust Commercial |
$14.41
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: Entrust Commercial |
$14.34
|
| Rate for Payer: Entrust Commercial |
$14.30
|
| Rate for Payer: First Choice Health Commercial |
$14.34
|
| Rate for Payer: First Choice Health Commercial |
$14.41
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.30
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.57
|
| Rate for Payer: HealthUtah PPO |
$15.05
|
| Rate for Payer: HealthUtah PPO |
$15.10
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: HealthUtah PPO |
$15.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Multiplan Medicare/VA |
$8.21
|
| Rate for Payer: Multiplan Medicare/VA |
$8.13
|
| Rate for Payer: Multiplan Medicare/VA |
$8.14
|
| Rate for Payer: Multiplan Medicare/VA |
$8.18
|
| Rate for Payer: Multiplan Medicare/VA |
$8.15
|
| Rate for Payer: One Health Plan of WY PPO |
$14.75
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: One Health Plan of WY PPO |
$14.80
|
| Rate for Payer: One Health Plan of WY PPO |
$14.87
|
| Rate for Payer: PacificSource Commercial |
$13.54
|
| Rate for Payer: PacificSource Commercial |
$13.65
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PacificSource Commercial |
$13.59
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: PHCS PPO |
$14.87
|
| Rate for Payer: PHCS PPO |
$14.75
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: PHCS PPO |
$14.80
|
| Rate for Payer: Three Rivers PPO |
$11.32
|
| Rate for Payer: Three Rivers PPO |
$11.38
|
| Rate for Payer: Three Rivers PPO |
$11.29
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$8.65
|
| Rate for Payer: TriWest Veterans Administration |
$8.61
|
| Rate for Payer: TriWest Veterans Administration |
$8.58
|
| Rate for Payer: TriWest Veterans Administration |
$8.57
|
| Rate for Payer: TriWest Veterans Administration |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$14.35
|
| Rate for Payer: United Healthcare Commercial |
$14.42
|
| Rate for Payer: United Healthcare Commercial |
$14.34
|
| Rate for Payer: United Healthcare Commercial |
$14.49
|
| Rate for Payer: United Healthcare Commercial |
$14.37
|
| Rate for Payer: United Healthcare Medicare |
$8.65
|
| Rate for Payer: United Healthcare Medicare |
$8.56
|
| Rate for Payer: United Healthcare Medicare |
$8.57
|
| Rate for Payer: United Healthcare Medicare |
$8.58
|
| Rate for Payer: United Healthcare Medicare |
$8.61
|
| Rate for Payer: WINHealth Partners Commercial |
$14.72
|
| Rate for Payer: WINHealth Partners Commercial |
$14.73
|
| Rate for Payer: WINHealth Partners Commercial |
$14.87
|
| Rate for Payer: WINHealth Partners Commercial |
$14.80
|
| Rate for Payer: WINHealth Partners Commercial |
$14.75
|
| Rate for Payer: Wise Provider Network Commercial |
$14.41
|
| Rate for Payer: Wise Provider Network Commercial |
$14.34
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.30
|
|
|
DEXTROSE 5 % IV BOLUS [400293]
|
Facility
|
OP
|
$15.17
|
|
|
Service Code
|
HCPCS J7060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$15.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.87
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.75
|
| Rate for Payer: Aetna of WY Medicare |
$10.01
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Aetna of WY Medicare |
$9.93
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.45
|
| Rate for Payer: Altius Commercial |
$14.56
|
| Rate for Payer: Beech Street Commercial |
$14.75
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Beech Street Commercial |
$14.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.60
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.60
|
| Rate for Payer: Cigna of WY Commercial |
$14.87
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Cigna of WY Commercial |
$14.75
|
| Rate for Payer: Entrust Commercial |
$14.30
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: Entrust Commercial |
$14.41
|
| Rate for Payer: First Choice Health Commercial |
$14.41
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.65
|
| Rate for Payer: HealthUtah PPO |
$15.05
|
| Rate for Payer: HealthUtah PPO |
$15.17
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Multiplan Medicare/VA |
$8.21
|
| Rate for Payer: Multiplan Medicare/VA |
$8.13
|
| Rate for Payer: Multiplan Medicare/VA |
$8.15
|
| Rate for Payer: One Health Plan of WY PPO |
$14.75
|
| Rate for Payer: One Health Plan of WY PPO |
$14.87
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.65
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PacificSource Commercial |
$13.54
|
| Rate for Payer: PHCS PPO |
$14.75
|
| Rate for Payer: PHCS PPO |
$14.87
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: Three Rivers PPO |
$11.38
|
| Rate for Payer: Three Rivers PPO |
$11.29
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$8.56
|
| Rate for Payer: TriWest Veterans Administration |
$8.58
|
| Rate for Payer: TriWest Veterans Administration |
$8.65
|
| Rate for Payer: United Healthcare Commercial |
$14.37
|
| Rate for Payer: United Healthcare Commercial |
$14.34
|
| Rate for Payer: United Healthcare Commercial |
$14.49
|
| Rate for Payer: United Healthcare Medicare |
$8.65
|
| Rate for Payer: United Healthcare Medicare |
$8.58
|
| Rate for Payer: United Healthcare Medicare |
$8.56
|
| Rate for Payer: WINHealth Partners Commercial |
$14.87
|
| Rate for Payer: WINHealth Partners Commercial |
$14.75
|
| Rate for Payer: WINHealth Partners Commercial |
$14.72
|
| Rate for Payer: Wise Provider Network Commercial |
$14.41
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.30
|
|
|
DEXTROSE 5 % IV BOLUS [400293]
|
Facility
|
IP
|
$15.02
|
|
|
Service Code
|
HCPCS J7060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.87
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.75
|
| Rate for Payer: Aetna of WY Medicare |
$9.63
|
| Rate for Payer: Aetna of WY Medicare |
$9.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.61
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.56
|
| Rate for Payer: Altius Commercial |
$14.45
|
| Rate for Payer: Beech Street Commercial |
$14.75
|
| Rate for Payer: Beech Street Commercial |
$14.87
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.87
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Cigna of WY Commercial |
$14.75
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: Entrust Commercial |
$14.30
|
| Rate for Payer: Entrust Commercial |
$14.41
|
| Rate for Payer: First Choice Health Commercial |
$14.30
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.18
|
| Rate for Payer: HealthUtah PPO |
$15.17
|
| Rate for Payer: HealthUtah PPO |
$15.05
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Multiplan Medicare/VA |
$8.70
|
| Rate for Payer: Multiplan Medicare/VA |
$8.79
|
| Rate for Payer: Multiplan Medicare/VA |
$8.72
|
| Rate for Payer: One Health Plan of WY PPO |
$14.75
|
| Rate for Payer: One Health Plan of WY PPO |
$14.87
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.54
|
| Rate for Payer: PacificSource Commercial |
$13.65
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.87
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: PHCS PPO |
$14.75
|
| Rate for Payer: Three Rivers PPO |
$11.38
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: Three Rivers PPO |
$11.29
|
| Rate for Payer: TriWest Veterans Administration |
$9.25
|
| Rate for Payer: TriWest Veterans Administration |
$9.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.18
|
| Rate for Payer: United Healthcare Commercial |
$14.49
|
| Rate for Payer: United Healthcare Commercial |
$14.37
|
| Rate for Payer: United Healthcare Commercial |
$14.34
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: United Healthcare Medicare |
$9.18
|
| Rate for Payer: United Healthcare Medicare |
$9.16
|
| Rate for Payer: WINHealth Partners Commercial |
$14.27
|
| Rate for Payer: WINHealth Partners Commercial |
$14.30
|
| Rate for Payer: WINHealth Partners Commercial |
$14.41
|
| Rate for Payer: Wise Provider Network Commercial |
$14.41
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.30
|
|
|
DIAB MANAGE TRN IND/GROUP
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS G0109
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Aetna of WY Medicare |
$15.30
|
| Rate for Payer: Beech Street Commercial |
$51.30
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: First Choice Health Commercial |
$48.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.30
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$13.00
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$51.30
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: WINHealth Partners Commercial |
$51.30
|
|
|
DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX
|
Professional
|
Both
|
$2,072.00
|
|
|
Service Code
|
HCPCS 29805
|
| Min. Negotiated Rate |
$388.32 |
| Max. Negotiated Rate |
$2,072.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,030.56
|
| Rate for Payer: Aetna of WY Medicare |
$456.85
|
| Rate for Payer: Beech Street Commercial |
$1,968.40
|
| Rate for Payer: Cash Price |
$1,450.40
|
| Rate for Payer: Cash Price |
$1,450.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,009.84
|
| Rate for Payer: Cigna of WY Commercial |
$2,030.56
|
| Rate for Payer: First Choice Health Commercial |
$1,864.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,968.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$456.85
|
| Rate for Payer: HealthUtah PPO |
$2,072.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,009.84
|
| Rate for Payer: Multiplan Medicare/VA |
$388.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,030.56
|
| Rate for Payer: PacificSource Commercial |
$1,864.80
|
| Rate for Payer: PHCS PPO |
$1,968.40
|
| Rate for Payer: Three Rivers PPO |
$1,554.00
|
| Rate for Payer: TriWest Veterans Administration |
$456.85
|
| Rate for Payer: United Healthcare Commercial |
$1,968.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,761.20
|
|
|
DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 29805 80
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Beech Street Commercial |
$342.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: First Choice Health Commercial |
$324.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$342.00
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: WINHealth Partners Commercial |
$306.00
|
|
|
DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 38220 80
|
| Min. Negotiated Rate |
$603.75 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$788.90
|
| Rate for Payer: Beech Street Commercial |
$764.75
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$780.85
|
| Rate for Payer: Cigna of WY Commercial |
$788.90
|
| Rate for Payer: First Choice Health Commercial |
$724.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$764.75
|
| Rate for Payer: HealthUtah PPO |
$805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$780.85
|
| Rate for Payer: One Health Plan of WY PPO |
$788.90
|
| Rate for Payer: PacificSource Commercial |
$724.50
|
| Rate for Payer: PHCS PPO |
$764.75
|
| Rate for Payer: Three Rivers PPO |
$603.75
|
| Rate for Payer: United Healthcare Commercial |
$764.75
|
| Rate for Payer: WINHealth Partners Commercial |
$684.25
|
|
|
DIAGNOSTIC LUMBAR SPINAL PUNCTURE
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 62270
|
| Min. Negotiated Rate |
$50.92 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$268.52
|
| Rate for Payer: Aetna of WY Medicare |
$59.91
|
| Rate for Payer: Beech Street Commercial |
$260.30
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$265.78
|
| Rate for Payer: Cigna of WY Commercial |
$268.52
|
| Rate for Payer: First Choice Health Commercial |
$246.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$260.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.91
|
| Rate for Payer: HealthUtah PPO |
$274.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$265.78
|
| Rate for Payer: Multiplan Medicare/VA |
$50.92
|
| Rate for Payer: One Health Plan of WY PPO |
$268.52
|
| Rate for Payer: PacificSource Commercial |
$246.60
|
| Rate for Payer: PHCS PPO |
$260.30
|
| Rate for Payer: Three Rivers PPO |
$205.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.91
|
| Rate for Payer: United Healthcare Commercial |
$260.30
|
| Rate for Payer: WINHealth Partners Commercial |
$232.90
|
|
|
DIAPER BARIATRIC BRIEFS 2XL
|
Facility
|
OP
|
$26.08
|
|
| Hospital Charge Code |
2400226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.56
|
| Rate for Payer: Aetna of WY Medicare |
$17.21
|
| Rate for Payer: Altius Commercial |
$25.04
|
| Rate for Payer: Beech Street Commercial |
$25.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.30
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.30
|
| Rate for Payer: Cigna of WY Commercial |
$25.56
|
| Rate for Payer: Entrust Commercial |
$24.78
|
| Rate for Payer: First Choice Health Commercial |
$24.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.87
|
| Rate for Payer: HealthUtah PPO |
$26.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.30
|
| Rate for Payer: Multiplan Medicare/VA |
$14.12
|
| Rate for Payer: One Health Plan of WY PPO |
$25.56
|
| Rate for Payer: PacificSource Commercial |
$23.47
|
| Rate for Payer: PHCS PPO |
$25.56
|
| Rate for Payer: Three Rivers PPO |
$19.56
|
| Rate for Payer: TriWest Veterans Administration |
$14.87
|
| Rate for Payer: United Healthcare Commercial |
$24.91
|
| Rate for Payer: United Healthcare Medicare |
$14.87
|
| Rate for Payer: WINHealth Partners Commercial |
$25.56
|
| Rate for Payer: Wise Provider Network Commercial |
$24.78
|
|
|
DIAPER BARIATRIC BRIEFS 2XL
|
Facility
|
IP
|
$26.08
|
|
| Hospital Charge Code |
2400226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.56
|
| Rate for Payer: Aetna of WY Medicare |
$16.69
|
| Rate for Payer: Altius Commercial |
$25.04
|
| Rate for Payer: Beech Street Commercial |
$25.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.30
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.30
|
| Rate for Payer: Cigna of WY Commercial |
$25.56
|
| Rate for Payer: Entrust Commercial |
$24.78
|
| Rate for Payer: First Choice Health Commercial |
$24.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.91
|
| Rate for Payer: HealthUtah PPO |
$26.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.30
|
| Rate for Payer: Multiplan Medicare/VA |
$15.11
|
| Rate for Payer: One Health Plan of WY PPO |
$25.56
|
| Rate for Payer: PacificSource Commercial |
$23.47
|
| Rate for Payer: PHCS PPO |
$25.56
|
| Rate for Payer: Three Rivers PPO |
$19.56
|
| Rate for Payer: TriWest Veterans Administration |
$15.91
|
| Rate for Payer: United Healthcare Commercial |
$24.91
|
| Rate for Payer: United Healthcare Medicare |
$15.91
|
| Rate for Payer: WINHealth Partners Commercial |
$24.78
|
| Rate for Payer: Wise Provider Network Commercial |
$24.78
|
|
|
DIAPER LG 48"-58" FITRIGHT
|
Facility
|
OP
|
$18.66
|
|
| Hospital Charge Code |
2400242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.29
|
| Rate for Payer: Aetna of WY Medicare |
$12.32
|
| Rate for Payer: Altius Commercial |
$17.91
|
| Rate for Payer: Beech Street Commercial |
$18.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.10
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.10
|
| Rate for Payer: Cigna of WY Commercial |
$18.29
|
| Rate for Payer: Entrust Commercial |
$17.73
|
| Rate for Payer: First Choice Health Commercial |
$17.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.64
|
| Rate for Payer: HealthUtah PPO |
$18.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.10
|
| Rate for Payer: Multiplan Medicare/VA |
$10.10
|
| Rate for Payer: One Health Plan of WY PPO |
$18.29
|
| Rate for Payer: PacificSource Commercial |
$16.79
|
| Rate for Payer: PHCS PPO |
$18.29
|
| Rate for Payer: Three Rivers PPO |
$14.00
|
| Rate for Payer: TriWest Veterans Administration |
$10.64
|
| Rate for Payer: United Healthcare Commercial |
$17.82
|
| Rate for Payer: United Healthcare Medicare |
$10.64
|
| Rate for Payer: WINHealth Partners Commercial |
$18.29
|
| Rate for Payer: Wise Provider Network Commercial |
$17.73
|
|
|
DIAPER LG 48"-58" FITRIGHT
|
Facility
|
IP
|
$18.66
|
|
| Hospital Charge Code |
2400242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.29
|
| Rate for Payer: Aetna of WY Medicare |
$11.94
|
| Rate for Payer: Altius Commercial |
$17.91
|
| Rate for Payer: Beech Street Commercial |
$18.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.10
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.10
|
| Rate for Payer: Cigna of WY Commercial |
$18.29
|
| Rate for Payer: Entrust Commercial |
$17.73
|
| Rate for Payer: First Choice Health Commercial |
$17.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.38
|
| Rate for Payer: HealthUtah PPO |
$18.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.10
|
| Rate for Payer: Multiplan Medicare/VA |
$10.81
|
| Rate for Payer: One Health Plan of WY PPO |
$18.29
|
| Rate for Payer: PacificSource Commercial |
$16.79
|
| Rate for Payer: PHCS PPO |
$18.29
|
| Rate for Payer: Three Rivers PPO |
$14.00
|
| Rate for Payer: TriWest Veterans Administration |
$11.38
|
| Rate for Payer: United Healthcare Commercial |
$17.82
|
| Rate for Payer: United Healthcare Medicare |
$11.38
|
| Rate for Payer: WINHealth Partners Commercial |
$17.73
|
| Rate for Payer: Wise Provider Network Commercial |
$17.73
|
|
|
DIAPER M 32-42" FITRIGHT
|
Facility
|
IP
|
$17.50
|
|
| Hospital Charge Code |
2400249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.15
|
| Rate for Payer: Aetna of WY Medicare |
$11.20
|
| Rate for Payer: Altius Commercial |
$16.80
|
| Rate for Payer: Beech Street Commercial |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.98
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.98
|
| Rate for Payer: Cigna of WY Commercial |
$17.15
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.68
|
| Rate for Payer: HealthUtah PPO |
$17.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.98
|
| Rate for Payer: Multiplan Medicare/VA |
$10.14
|
| Rate for Payer: One Health Plan of WY PPO |
$17.15
|
| Rate for Payer: PacificSource Commercial |
$15.75
|
| Rate for Payer: PHCS PPO |
$17.15
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$10.68
|
| Rate for Payer: United Healthcare Commercial |
$16.71
|
| Rate for Payer: United Healthcare Medicare |
$10.68
|
| Rate for Payer: WINHealth Partners Commercial |
$16.62
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
DIAPER M 32-42" FITRIGHT
|
Facility
|
OP
|
$17.50
|
|
| Hospital Charge Code |
2400249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.15
|
| Rate for Payer: Aetna of WY Medicare |
$11.55
|
| Rate for Payer: Altius Commercial |
$16.80
|
| Rate for Payer: Beech Street Commercial |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.98
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.98
|
| Rate for Payer: Cigna of WY Commercial |
$17.15
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.98
|
| Rate for Payer: HealthUtah PPO |
$17.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.98
|
| Rate for Payer: Multiplan Medicare/VA |
$9.48
|
| Rate for Payer: One Health Plan of WY PPO |
$17.15
|
| Rate for Payer: PacificSource Commercial |
$15.75
|
| Rate for Payer: PHCS PPO |
$17.15
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.98
|
| Rate for Payer: United Healthcare Commercial |
$16.71
|
| Rate for Payer: United Healthcare Medicare |
$9.98
|
| Rate for Payer: WINHealth Partners Commercial |
$17.15
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
DIAPER SZ 1 8-14 LBS
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2450011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
DIAPER SZ 1 8-14 LBS
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2450011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
DIAPER SZ 2 12-18 LBS
|
Facility
|
IP
|
$2.13
|
|
| Hospital Charge Code |
2450013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.09
|
| Rate for Payer: Aetna of WY Medicare |
$1.36
|
| Rate for Payer: Altius Commercial |
$2.04
|
| Rate for Payer: Beech Street Commercial |
$2.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.07
|
| Rate for Payer: Cigna of WY Commercial |
$2.09
|
| Rate for Payer: Entrust Commercial |
$2.02
|
| Rate for Payer: First Choice Health Commercial |
$2.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.30
|
| Rate for Payer: HealthUtah PPO |
$2.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.07
|
| Rate for Payer: Multiplan Medicare/VA |
$1.23
|
| Rate for Payer: One Health Plan of WY PPO |
$2.09
|
| Rate for Payer: PacificSource Commercial |
$1.92
|
| Rate for Payer: PHCS PPO |
$2.09
|
| Rate for Payer: Three Rivers PPO |
$1.60
|
| Rate for Payer: TriWest Veterans Administration |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$2.03
|
| Rate for Payer: United Healthcare Medicare |
$1.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2.02
|
| Rate for Payer: Wise Provider Network Commercial |
$2.02
|
|
|
DIAPER SZ 2 12-18 LBS
|
Facility
|
OP
|
$2.13
|
|
| Hospital Charge Code |
2450013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.09
|
| Rate for Payer: Aetna of WY Medicare |
$1.41
|
| Rate for Payer: Altius Commercial |
$2.04
|
| Rate for Payer: Beech Street Commercial |
$2.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.07
|
| Rate for Payer: Cigna of WY Commercial |
$2.09
|
| Rate for Payer: Entrust Commercial |
$2.02
|
| Rate for Payer: First Choice Health Commercial |
$2.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.21
|
| Rate for Payer: HealthUtah PPO |
$2.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.07
|
| Rate for Payer: Multiplan Medicare/VA |
$1.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2.09
|
| Rate for Payer: PacificSource Commercial |
$1.92
|
| Rate for Payer: PHCS PPO |
$2.09
|
| Rate for Payer: Three Rivers PPO |
$1.60
|
| Rate for Payer: TriWest Veterans Administration |
$1.21
|
| Rate for Payer: United Healthcare Commercial |
$2.03
|
| Rate for Payer: United Healthcare Medicare |
$1.21
|
| Rate for Payer: WINHealth Partners Commercial |
$2.09
|
| Rate for Payer: Wise Provider Network Commercial |
$2.02
|
|
